Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Sep 2008
Case ReportsTransdermal scopolamine to reduce salivation and possibly aspiration after stroke.
We report two cases illustrating a potential use of transdermal scopolamine to reduce salivation in acute stroke. We speculate that this may lead to reduced aspiration and possibly also less pneumonia. However, the treatment is associated with side effects. Finally, we suggest that this use of transdermal scopolamine in stroke may be a topic for a randomized clinical trial.
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J Stroke Cerebrovasc Dis · Sep 2008
ReviewExtracranial-intracranial bypass to reduce the risk of ischemic stroke in intracranial aneurysms of the anterior cerebral circulation: a systematic review.
If clip application or coil placement for treatment of intracranial (IC) aneurysms is not feasible, the parent vessel can be occluded to induce thrombosis of the aneurysm. In the case that such an occlusion cannot be tolerated without subsequent sequel, the additional construction of an extracranial (EC)-IC bypass is needed for sufficient ipsilateral revascularization. Hitherto, the effectiveness of this combined treatment option was not investigated in a controlled randomized trial or in a review. The aim of the current report was to analyze clinical effectiveness of EC-IC bypass for cerebral revascularization in patients with Hunterian ligation in case of otherwise untreatable aneurysm of the anterior cerebral circulation. Special reference was given to different hemodynamic subgroups. ⋯ Neurologic function and subsequent stroke attributable to hemodynamic insufficiency in patients with otherwise untreatable IC aneurysm improves significantly by EC-IC bypass surgery if the brain area corresponding to the impaired neurologic function remains viable. The hemodynamic parameters observed for patients who experience improved neurologic function or diminished stroke risk profile after EC-IC bypass surgery contain both significantly elevated OEF and CBF/CBV. Therefore, hemodynamic state represents an important indicator for EC-IC bypass surgery. The large amount of data leads to narrow stroke with no significant heterogeneity, and the overall results are, therefore, likely to be statistically robust.
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J Stroke Cerebrovasc Dis · Sep 2008
Comparative StudyOlder age does not increase risk of hemorrhagic complications after intravenous and/or intra-arterial thrombolysis for acute stroke.
The elderly have significantly higher incidence of ischemic stroke and have higher mortality and morbidity compared with younger patients. Intracranial hemorrhage (ICH) after thrombolysis is one of the causes of unfavorable outcome. However, it is unclear whether age over 80 years is a predictor for hemorrhagic transformation after intravenous, intra-arterial, or a combination of both thrombolytic therapies. ⋯ Risks of ICH after thrombolysis for acute ischemic stroke are similar in patients over and under 80 years of age. Our data suggest that the decision to provide thrombolytic therapy should not be solely based on patient's age.
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J Stroke Cerebrovasc Dis · Sep 2008
Case ReportsHemorrhage from a falx meningioma after internal use of low-dose aspirin.
We report a case in which hemorrhage occurred in an asymptomatic falx meningioma known beforehand, after the internal use of low-dose aspirin for 16 months. Our case is the second one in which hemorrhage from a meningioma may have been induced by aspirin prophylaxis. ⋯ Furthermore, inadequate control of hypertension may have been another cause of hemorrhage. Although it is difficult to solely attribute intratumoral hemorrhage to aspirin, we have to be careful when prescribing aspirin for patients who have asymptomatic meningioma.